Healthcare Provider Details

I. General information

NPI: 1902596067
Provider Name (Legal Business Name): FAIZA SHAKEEL KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DUNWOODY PARK STE 104
ATLANTA GA
30338-6711
US

IV. Provider business mailing address

325 OAK ALLEY CT
JOHNS CREEK GA
30022-8032
US

V. Phone/Fax

Practice location:
  • Phone: 678-576-7563
  • Fax:
Mailing address:
  • Phone: 678-576-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71875
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: